Antibiotic prophylaxis for preventing infectious complications in orthognathic surgery

Romina Brignardello‐Petersen; Alonso Carrasco‐Labra; Ignacio Araya; Nicolás Yanine; Luis Cordova Jara; Julio Villanueva

doi:10.1002/14651858.CD010266.pub2

Profilaxia antibiótica para prevenir complicações infecciosas em cirurgias ortognáticas

Appendices

Appendix 1. Ovid MEDLINE Search Strategy

1 exp Orthognathic Surgery/ (87)
2 exp Orthognathic Surgical Procedures/ (1052)
3 exp Osteotomy, Le Fort/ (1454)
4 (orthognathic adj5 surg*).tw. (2516)
5 (maxillary osteotom* or Le Fort osteotom* or (mandibular adj5 osteotom*) or vertical ramus osteotom* or genioplast*).tw. (2160)
6 or/1‐5 (5695)
7 exp Antibiotic Prophylaxis/ (8683)
8 exp Anti‐Bacterial Agents/ (527266)
9 (antibiotic* or cephalosporin* or cefazolin or cefuroxime or amox?cillin* or clindam?cin or penicillin* or levofloxacin).tw. (260904)
10 or/7‐9 (629847)
11 6 and 10 (65)
12 randomized controlled trial.pt. (374960)
13 controlled clinical trial.pt. (88427)
14 randomi?ed.ab. (327203)
15 placebo.ab. (146420)
16 clinical trials as topic.sh. (170264)
17 randomly.ab. (193925)
18 trial.ti. (117951)
19 or/12‐18 (878362)
20 exp animals/ not humans.sh. (3947165)
21 19 not 20 (807587)
22 11 and 21 (13)

Appendix 2. Ovid EMBASE search strategy

1 exp orthognathic surgery/ (1497)
2 exp maxilla osteotomy/ (2054)
3 (orthognathic adj5 surg*).tw. (2946)
4 (maxillary osteotom* or Le Fort osteotom* or (mandibular adj5 osteotom*) or vertical ramus osteotom* or genioplast*).tw. (2495)
5 or/1‐4 (6681)
6 exp antibiotic prophylaxis/ (20802)
7 exp antibiotic agent/ (983143)
8 (antibiotic* or cephalosporin* or cefazolin or cefuroxime or amox?cillin* or clindam?cin or penicillin* or levofloxacin).tw. (345777)
9 or/6‐8 (1089776)
10 5 and 9 (142)
11 Randomized controlled trials/ (52460)
12 Single‐Blind Method/ (18336)
13 Double‐Blind Method/ (115948)
14 Crossover Procedure/ (39087)
15 (random$ or factorial$ or crossover$ or cross over$ or cross‐over$ or placebo$ or assign$ or allocat$ or volunteer$).ti,ab. (1331662)
16 (doubl$ adj blind$).ti,ab. (146816)
17 (singl$ adj blind$).ti,ab. (14503)
18 or/11‐17 (1399256)
19 exp animals/ or exp invertebrate/ or animal experiment/ or animal model/ or animal tissue/ or animal cell/ or nonhuman/ (20296020)
20 human/ or human cell/ (14775294)
21 and/19‐20 (14728616)
22 19 not 21 (5567404)
23 18 not 22 (1207860)
24 10 and 23 (20)

Appendix 3. EBSCO CINAHL search strategy

S23 S10 AND S22
S22 S11 or S12 or S13 or S14 or S15 or S16 or S17 or S18 or S19 or S20 or S21
S21 MH "Quantitative Studies"
S20 TI placebo* or AB placebo*
S19 MH "Placebos"
S18 TI random* allocat* or AB random* allocat*
S17 MH "Random Assignment"
S16 TI randomi?ed control* trial* or AB randomi?ed control* trial*
S15 AB ( singl* or doubl* or trebl* or tripl* ) and AB ( blind* or mask* )
S14 TI ( singl* or doubl* or trebl* or tripl* ) and TI ( blind* or mask* )
S13 TI clinic* N1 trial* or AB clinic* N1 trial*
S12 PT Clinical trial
S11 MH "Clinical Trials+"
S10 S5 and S9
S9 S6 or S7 or S8
S8 TI ( (antibiotic* or cephalosporin* or cefazolin or cefuroxime or amox?cillin* or clindam?cin or penicillin* or levofloxacin) ) OR AB ( (antibiotic* or cephalosporin* or cefazolin or cefuroxime or amox?cillin* or clindam?cin or penicillin* or levofloxacin) )
S7 (MH "Antibiotics+")
S6 (MH "Antibiotic Prophylaxis")
S5 S1 or S2 or S3 or S4
S4 TI (mandibular N5 osteotom*) OR AB (mandibular N5 osteotom*)
S3 TI ( (maxillary osteotom* or Le Fort osteotom* or vertical ramus osteotom* or genioplast*) ) OR AB ( (maxillary osteotom* or Le Fort osteotom* or vertical ramus osteotom* or genioplast*) )
S2 TI (orthognathic N5 surg*) OR AB (orthognathic N5 surg*)
S1 (MH "Orthognathic Surgery")

Figure 1

Flow diagram.

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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Analysis 1.1

Comparison 1 Short‐term versus long‐term antibiotic prophylaxis, Outcome 1 Surgical site infection.

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Analysis 2.1

Comparison 2 Sensitivity analysis: short‐term versus long‐term antibiotic prophylaxis, Outcome 1 Surgical site infection.

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Analysis 3.1

Comparison 3 Preoperative versus short‐term antibiotic prophylaxis, Outcome 1 Surgical site infection.

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Analysis 3.2

Comparison 3 Preoperative versus short‐term antibiotic prophylaxis, Outcome 2 Adverse events.

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Analysis 4.1

Comparison 4 Amoxicillin versus ampicillin, Outcome 1 Surgical site infection.

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Analysis 4.2

Comparison 4 Amoxicillin versus ampicillin, Outcome 2 Adverse events.

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Analysis 5.1

Comparison 5 Amoxicillin and clavulanic acid versus cefuroxime, Outcome 1 Surgical site infection.

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Short‐term antibiotic prophylaxis compared with long‐term antibiotic prophylaxis in patients undergoing orthognathic surgery
Patient or population: patients undergoing orthognathic surgery Intervention: short‐term antibiotic prophylaxis Comparison: long‐term antibiotic prophylaxis
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No. of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Short‐term	Long‐term
Surgical site infection Follow‐up: 2 to 36 weeks	168 per 1000^a	71 per 1000 (41 to 125)	RR 0.42 (0.24 to 0.74)	472 (7 studies)	⊕⊕⊕⊝ moderate^b	This outcome was measured using different definitions. We accepted all authors' definitions
Systemic infection	Not reported				‐	This outcome was not reported in any of the trials
Adverse events	Not reported				‐	This outcome was not reported in any of the trials
Duration of hospital stay	Not reported				‐	This outcome was not reported in any of the trials
Health‐related quality of life	Not reported				‐	This outcome was not reported in any of the trials
The basis for the assumed risk* (e.g. mean control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio.
GRADE Working Group grades of evidence. High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
^aAssumed risk based on control arms of included trials. ^bMost of these trials were judged to have unclear risk of bias in the domains of allocation concealment and blinding.

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Preoperative antibiotic prophylaxis compared with short‐term antibiotic prophylaxis in patients undergoing orthognathic surgery
Patient or population: patients undergoing orthognathic surgery Intervention: preoperative antibiotic prophylaxis Comparison: short‐term antibiotic prophylaxis
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No. of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Preoperative	Short‐term
Surgical site infection Follow‐up: 4 to 12 weeks	82 per 1000^a	28 per 1000 (8 to 101)	RR 0.34 (0.09 to 1.22)	220 (2 studies)	⊕⊕⊝⊝ low^b,c	This outcome was measured using different definitions. We accepted all authors' definitions
Adverse events Follow‐up: up to 12 weeks	0 per 35 See comment	0 per 35 See comment	Not estimable	70 (1 study)	⊕⊕⊝⊝ low^d,e	No adverse events were reported in any of arms of the trial
Systemic infection	Not reported				‐	This outcome was not reported in any of the trials
Duration of hospital stay	Not reported				‐	This outcome was not reported in any of the trials
Health‐related quality of life	Not reported				‐	This outcome was not reported in any of the trials
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk Ratio
GRADE Working Group grades of evidence. High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
^aAssumed risk based on control arms of included trials. ^bMost of the trials were judged to have unclear risk of bias in the domains of allocation concealment and blinding. ^cThe 95% CI of the pooled estimate suggests both benefit and harm. ^dThe trial was judged to have unclear risk of bias in the domains of allocation concealment and blinding. ^eThe number of participants included in this analysis is below the optimal information size.

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Comparison 1. Short‐term versus long‐term antibiotic prophylaxis

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Surgical site infection Show forest plot	7	472	Risk Ratio (IV, Random, 95% CI)	0.42 [0.24, 0.74]

Comparison 1. Short‐term versus long‐term antibiotic prophylaxis

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Comparison 2. Sensitivity analysis: short‐term versus long‐term antibiotic prophylaxis

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Surgical site infection Show forest plot	6	438	Risk Ratio (IV, Random, 95% CI)	0.41 [0.22, 0.75]

Comparison 2. Sensitivity analysis: short‐term versus long‐term antibiotic prophylaxis

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Comparison 3. Preoperative versus short‐term antibiotic prophylaxis

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Surgical site infection Show forest plot	2	220	Risk Ratio (IV, Fixed, 95% CI)	0.34 [0.09, 1.22]

2 Adverse events Show forest plot	1	70	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 3. Preoperative versus short‐term antibiotic prophylaxis

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Comparison 4. Amoxicillin versus ampicillin

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Surgical site infection Show forest plot	1		Risk Difference (IV, Random, 95% CI)	Totals not selected

2 Adverse events Show forest plot	1	42	Risk Ratio (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 4. Amoxicillin versus ampicillin

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Comparison 5. Amoxicillin and clavulanic acid versus cefuroxime

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Surgical site infection Show forest plot	1		Risk Ratio (IV, Fixed, 95% CI)	Totals not selected

Comparison 5. Amoxicillin and clavulanic acid versus cefuroxime

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Profilaxia antibiótica para prevenir complicações infecciosas em cirurgias ortognáticas

Appendices

Appendix 1. Ovid MEDLINE Search Strategy

Appendix 2. Ovid EMBASE search strategy

Appendix 3. EBSCO CINAHL search strategy

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Appendices

Appendix 1. Ovid MEDLINE Search Strategy

Appendix 2. Ovid EMBASE search strategy

Appendix 3. EBSCO CINAHL search strategy

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